Management of type 2 diabetes mellitus in older adults: eight case studies with focus SGLT-2 inhibitors and metformin

ABSTRACT

Objectives

Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been recently introduced for type 2 diabetes treatment with significant cardiovascular, renal benefits. Yet, they have frequently been refrained in older adults. Metformin is regarded the first-line diabetes therapy for all ages; still it is associated with weight loss and frailty in older adults. We aimed to outline our experience with three oldest-old patients with high cardiovascular risk managed with SGLT-2 inhibitors, and five patients with anorexia/weight loss managed by metformin cessation.

Methods

We outlined demographics, comorbidities, geriatric syndromes, functional status, and diabetes duration, and presented the changes in frailty by noting pre-intervention and post-intervention frailty scores. We outlined benefits and side effects related to SGLT-2 inhibitors, and the deprescription reasons and represcription practices of metformin therapy. We gave details on baseline and current diabetes treatment, overall medication regimen, and current status of the patients.

Results

Among the case studies with SGLT-2 inhibitors, two patients were frail and reversed to pre-frailty status after SGLT-2 intervention, while the third patient was and remained robust. All patients had clinical improvements with better blood pressure and glucose control. Among the case studies treated with metformin, all were frail before the cessation of metformin. Four reversed to pre-frailty and one became robust after intervention.

Conclusion

The findings of our case studies suggest considering SGLT-2 inhibitors in patients with accompanying heart failure/high cardiovascular risk factors and cessation of metformin in those with malnutrition/malnutrition risk. These approaches have potential to improve frailty and inappropriate medication use in diabetic older adults.

KEYWORDS:

• Diabetes
• frailty
• malnutrition
• metformin
• older adults
• SGLT-2 inhibitors

Acknowledgments

The authors certify that they comply with ethical guidelines for authorship and publishing of the Acta Clinica Belgica. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Mirko Petrovic is the academic director of the European Geriatric Medicine Society.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and material

The data is available from the authors upon reasonable request.

Authors’ contributions

Gulistan Bahat: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing, Investigation, Supervision.Nezahat Muge Catikkas: Review & Editing.Mehmet Akif Karan: Review & Editing, Supervision.Mirko Petrovic: Writing – Review & Editing, Supervision.

Ethics approval

We obtained ethical approval from the Istanbul University Istanbul Medical School ethical board.

Consent to participate

We received informed consent from all participants.

Consent for publication

We received informed consent from all participants.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.